A rock and a hard place? Ministry of Defence | Defence News | MOD confirms loss of recruitment data

[Ian Batten]

James Cox wrote:

>
> The medical code of confidentiality is extremely simple.

And later

> Yes, it's complex and grey

Quite.

``When it comes to wider clinical audit - practice management,  
hospital administration - even epidemiology... alot of this works  
well with anonymized data.''

But you said that doctors shouldn't release patient data, period.   
Now you're making an exception, I think, for anonymized data.  Some  
clinical audit and epidemiology doesn't work with anonymized data,  
and as Ross has pointed out age+postcode+sex+one_detail is pretty  
much a unique identifier.  What to do then?  If the answer is that  
you want to shut down some research because of privacy concerns,  
fine, that's an honest argument (and one I have some sympathy with):  
but it's not simple, and a lot of different stakeholders have genuine  
and legitimate views on both sides.

> The point was, if you have a procedure (especially an elective  
> one), the hospital you go to isn't really permitted to inform a  
> next of kin, unless you consent or are somehow incapable of making  
> your own consent (e.g. being unconscious)

It's a hell of a lot more complex than that, as you well know.  The  
circumstances under which minors can seek treatment without reference  
to their parent/guardian are ill-defined and quite properly left up  
to doctors' discretion.  Symmetric with that, the circumstances under  
which parent/guardians can seek treatment for minors without the  
minor's explicit consent are likewise vague.  Some doctors would  
probably inform next-of-kin if a confused, borderline-Alzheimers'  
patient presented, and I think it's impossible to make hard and fast  
statements about that, too. Next-of-kin have limited and again vague  
powers of consent over incapacitated patients (something the new  
enduring power of attorney replacement whose name momentarily escapes  
me is designed to resolve).

Privacy wonks, like me and I suspect you, will argue in public that  
confidentiality trumps all other concerns.  That's not the position  
of the general public, and it's not in the end a position we would  
defend absolutely anyway.

I've told before of the row I had with the NHS about their urge to  
talk to my wife about my request for a vasectomy.  By contrast, my  
great uncle, who has few relatives, is showing the effects of several  
small strokes, is very confused, and is unable to make decisions  
about his own care.  Left to his own devices he would starve in his  
house (and has already made a fairly good attempt at doing so).  Does  
the confidentiality between him and his doctor trump, you know,  
caring for him?

ian